Network meta-analysis on efficacy and safety of different Janus kinase inhibitors for ulcerative colitis.

Abstract

In the absence of head-to-head comparisons, the objective of this study was to conduct a network meta-analysis (NMA) to indirectly compare the relative efficacy and safety of Janus kinase (JAK) inhibitors for ulcerative colitis (UC). We searched PubMed, EMBASE, Web of Science and Cochrane Library from the database inception until 13 August 2021. No randomized controlled trials (RCTs) that directly compared these interventions were identified. Therefore, a fixed-effects Bayesian NMA was conducted by identifying a connected (via comparison to placebo) network of RCTs. Ranking was assessed using surface under the cumulative ranking (SUCRA) probabilities. Seven RCTs including 3190 patients met the inclusion criteria. Filgotinib 100mg was ranked highest for induction of endoscopic remission (SUCRA, 0.67) whereas peficitinib 75mg BID was ranked highest for induction of clinical response (SUCRA, 0.72). Peficitinib 75mg was ranked highest for induction of mucosal healing (SUCRA, 0.71), whereas peficitinib 150mg was ranked highest for clinical remission (SUCRA, 0.74). Tofacitinib 3mg had the highest probability of being the best treatment in terms of change from baseline in Mayo score (SUCRA, 0.78). Adverse events (AEs) and treatment discontinuations or withdrawals from the study due to AEs did not differ between JAK inhibitors and placebo groups. Based on indirect comparisons, peficitinib 75mg/75mg BID/150mg, tofacitinib 3mg and filgotinib 100mg were the most efficacious JAK inhibitor interventions in patients with UC. However, head-to-head trials are warranted to inform clinical decision-making with greater confidence.